Congress Faces Renewed Push to Improve PACE
May 20, 2014 01:01 PM
The Program of All-Inclusive Care for the Elderly (PACE) is a joint Medicare and Medicaid program that coordinates the care of seniors with chronic conditions, so that they can live in the community as much as possible. PACE integrates acute, preventative, primary, and long-term services and supports through an adult day care center.
The National Council on Medicaid Home Care – a NAHC affiliate – reports on recent developments withing the PACE program:
On May 2, Congressmen Earl Blumenauer (OR-03) and Chris Smith (NJ-04) introduced the PACE Pilot Act (HR 4543), which called for the streamlining of the PACE program. The bill called for budget neutral reform, “increased operational flexibility” and a reduction in “technical and administrative barriers.” For the full bill, click here.
The PACE Pilot Act follows calls in March both from the President’s budget proposal for the Department of Health and Human Services (HHS) for Fiscal Year 2015, as well as from the Medicare-Medicaid Coordination Office of the Centers for Medicare & Medicaid Services’ (CMS) Fiscal Year 2013 Report to Congress to expand the PACE program to individuals between ages 21 and 55.
While the Bill did not explicitly call for an expansion of PACE to those individuals, Congressman Blumenauer stated that “there is a group of people out there who currently don’t qualify for PACE because of the age requirement. This bill allows us to see how we can bring them into the fold efficiently and affordably.” To see Blumenauer’s full quote, click here.
The past couple of months have seen major developments in PACE. In late March, Virginia Democratic Gov. Terry McAuliffe signedH.B. 702, giving all that request a PACE screening the right to such a screening, regardless of their eligibility for medical assistance under the state plan. To see a press release on the law, click here. In early April, Kansas announced that it would expand its PACE programs from eight to 59 counties.
Characteristics of PACE
Eligibility. To be eligible for PACE, a person must be 1) aged 55 or older; 2) need nursing home care as certified by their state; 3) be able to safely live in the community and 4) reside in a PACE service area.
Demographics. According to the National PACE Association, while beneficiaries have to need nursing home care to qualify for PACE, over 90 percent of PACE beneficiaries live in the home and community, versus only 7 percent living in a nursing home. Almost half (49 percent) of PACE enrollees are diagnosed with dementia.
Services provided. PACE provides many services, including: adult day care, home health, and therapies (occupational, physical, and recreational), medical care, personal care, prescription drugs, social services, and respite care. For a full list of services, click here.
Payment. Medicare enrollees have Medicare paying for all Medicare covered services. Medicaid enrollees either have no cost-sharing responsibility, or pay a small monthly payment for the long-term services and supports component of PACE. Payment is awarded to providers via a “capitated funding arrangement,” according to the National PACE Association.
PACE began in 1971, when three people executed articles of incorporation for the San Francisco-based Chinatown-North Beach Health Care Planning and Development Corporation, which was later named On Lok Senior Health Services. On Lok is a non-profit that integrates community-based care. In 1974, On Lok began receiving Medicaid reimbursement for adult day health services, and the following year provided housing assistance, in-home care, and home-delivered meals.
In 1990, the Centers for Medicare & Medicaid Services issued waivers to the first PACE centers. By 1994, the National PACE Association (NPA) was formed, and 11 PACE centers were operating in nine states. By 1997, PACE was recognized as a permanent provider type under both Medicare and Medicaid.
PACE centers continued to proliferate. In March 2014, the number of open PACE centers passed 100. As of this writing, 104 PACE centers provide care to approximately 56,000 beneficiaries in 31 states. For a complete history, click here.
The National Council on Medicaid Home Care supports PACE as a key program that provides home and community-based services to seniors with chronic care. The Council supports PACE’s expansion not only throughout the states in its current form, but to those between the ages of 21 and 55 as well, so long as these expansions do not compromise other state rebalancing initiatives such as Balancing Incentive Payment Program and Money Follows the Person. Home care agencies are encouraged to keep abreast of PACE developments in their states, and to contact the Council with any questions or concerns.